Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

Abstract

Acute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

Keywords

portal vein thrombosis - mesenteric vein thrombosis - portomesenteric thrombosis - splanchnic vein thrombosis - mesenteric ischemia - portal vein - superior mesenteric vein - venous thrombolysis

• References

• 1 Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008; 95 (10) 1245-1251
• 2 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J Vasc Surg 2005; 41 (01) 59-63
• 3 Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am 1997; 77 (02) 327-338
• 4 Salim S, Ekberg O, Elf J, Zarrouk M, Gottsäter A, Acosta S. Clinical implications of CT findings in mesenteric venous thrombosis at admission. Emerg Radiol 2018; 25 (04) 407-413
• 5 Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004; 91 (01) 17-27
• 6 Malkowski P, Pawlak J, Michalowicz B. , et al. Thrombolytic treatment of portal thrombosis. Hepatogastroenterology 2003; 50 (54) 2098-2100
• 7 Chawla YK, Bodh V. Portal vein thrombosis. J Clin Exp Hepatol 2015; 5 (01) 22-40
• 8 Amitrano L, Guardascione MA, Scaglione M. , et al. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol 2007; 102 (11) 2464-2470
• 9 Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med 2010; 15 (05) 407-418
• 10 Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med 2001; 345 (23) 1683-1688
• 11 Zarrouk M, Salim S, Elf J, Gottsäter A, Acosta S. Testing for thrombophilia in mesenteric venous thrombosis - Retrospective original study and systematic review. Best Pract Res Clin Gastroenterol 2017; 31 (01) 39-48
• 12 Clavien PA, Dürig M, Harder F. Venous mesenteric infarction: a particular entity. Br J Surg 1988; 75 (03) 252-255
• 13 Rhee RY, Gloviczki P, Mendonca CT. , et al. Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 1994; 20 (05) 688-697
• 14 Martinez JP, Hogan GJ. Mesenteric ischemia. Emerg Med Clin North Am 2004; 22 (04) 909-928
• 15 Leone M, Bechis C, Baumstarck K. , et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med 2015; 41 (04) 667-676
• 16 Acosta S, Block T, Björnsson S, Resch T, Björck M, Nilsson T. Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion. J Emerg Med 2012; 42 (06) 635-641
• 17 Brunaud L, Antunes L, Collinet-Adler S. , et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 2001; 34 (04) 673-679
• 18 Kanasaki S, Furukawa A, Fumoto K. , et al. Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics 2018; 38 (03) 945-961
• 19 Kim HK, Hwang D, Park S, Lee JM, Huh S. Treatment outcomes and risk factors for bowel infarction in patients with acute superior mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 2017; 5 (05) 638-646
• 20 European Association for the Study of the Liver. Electronic address: [e-mail]. Electronic address eee. EASL Clinical Practice Guidelines: vascular diseases of the liver. J Hepatol 2016; 64 (01) 179-202
• 21 DeLeve LD, Valla DC, Garcia-Tsao G. ; American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
• 22 Turnes J, García-Pagán JC, González M. , et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
• 23 Condat B, Pessione F, Helene Denninger M, Hillaire S, Valla D. Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy. Hepatology 2000; 32 (03) 466-470
• 24 Plessier A, Darwish-Murad S, Hernandez-Guerra M. , et al; European Network for Vascular Disorders of the Liver (EN-Vie). Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010; 51 (01) 210-218
• 25 Maldonado TS, Blumberg SN, Sheth SU. , et al. Mesenteric vein thrombosis can be safely treated with anticoagulation but is associated with significant sequelae of portal hypertension. J Vasc Surg Venous Lymphat Disord 2016; 4 (04) 400-406
• 26 Di Minno MN, Milone F, Milone M. , et al. Endovascular thrombolysis in acute mesenteric vein thrombosis: a 3-year follow-up with the rate of short and long-term sequaelae in 32 patients. Thromb Res 2010; 126 (04) 295-298
• 27 Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol 2005; 16 (05) 651-661
• 28 Kim HS, Patra A, Khan J, Arepally A, Streiff MB. Transhepatic catheter-directed thrombectomy and thrombolysis of acute superior mesenteric venous thrombosis. J Vasc Interv Radiol 2005; 16 (12) 1685-1691
• 29 Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging 2011; 36 (04) 390-398
• 30 Wang M-Q, Lin H-Y, Guo L-P, Liu F-Y, Duan F, Wang Z-J. Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach. World J Gastroenterol 2009; 15 (24) 3038-3045
• 31 Yang S, Liu B, Ding W, He C, Wu X, Li J. Acute superior mesenteric venous thrombosis: transcatheter thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery in eight patients. Cardiovasc Intervent Radiol 2015; 38 (01) 88-99
• 32 Liu F-Y, Wang M-Q, Fan Q-S, Duan F, Wang Z-J, Song P. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol 2009; 15 (40) 5028-5034
• 33 Klinger C, Riecken B, Schmidt A. , et al. Transjugular local thrombolysis with/without TIPS in patients with acute non-cirrhotic, non-malignant portal vein thrombosis. Dig Liver Dis 2017; 49 (12) 1345-1352
• 34 Kercher KW, Sing RF, Watson KW, Matthews BD, LeQuire MH, Heniford BT. Transhepatic thrombolysis in acute portal vein thrombosis after laparoscopic splenectomy. Surg Laparosc Endosc Percutan Tech 2002; 12 (02) 131-136
• 35 Ozkan U, Oğuzkurt L, Tercan F, Tokmak N. Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis. Diagn Interv Radiol 2006; 12 (02) 105-107
• 36 Rosenqvist K, Ebeling Barbier C, Rorsman F, Sangfelt P, Nyman R. Treatment of acute portomesenteric venous thrombosis with thrombectomy through a transjugular intrahepatic portosystemic shunt: a single-center experience. Acta Radiol 2018; 59 (08) 953-958
• 37 Farsad K, Fuss C, Kolbeck KJ. , et al. Transjugular intrahepatic portosystemic shunt creation using intravascular ultrasound guidance. J Vasc Interv Radiol 2012; 23 (12) 1594-1602
• 38 Hechelhammer L, Crook DW, Widmer U, Wildermuth S, Pfammatter T. Thrombosis of a superior mesenteric vein aneurysm: transarterial thrombolysis and transhepatic aspiration thrombectomy. Cardiovasc Intervent Radiol 2004; 27 (05) 551-555